Tuesday, 10 March 2020

Best response to the coronavirus? Altruism

By Richard A. Friedman, Published The Straits Times, 9 Mar 2020

Are you fearful about catching the coronavirus? Are you anxious about whether you're properly prepared for its arrival? You're in good company. In the past few days, I've had patients call or e-mail to ask me to double or even treble the dosage of their prescription antidepressant or anti-anxiety medication so that they can have a bigger supply on hand "just in case".

Throughout the United States, people are stockpiling food in anticipation of a shortage or quarantine measures. Supplies of Purell hand sanitiser flew off the shelves and are now hard to find or even unavailable online. I understand the impulse to secure one's safety in the face of a threat. But the fact is that if I increase the supply of medication for my patients, I could well deprive other patients of needed medication, so I reluctantly declined those requests.

As a psychiatrist, I frequently tell my patients that their anxieties and fears are out of proportion to reality, something that is often true and comforting for them to realise. But when the object of fear is a looming pandemic, all bets are off.

The coronavirus is an uncertain and unpredictable danger. This really grabs our attention, because we have been hardwired by evolution to respond aggressively to new threats. After all, it's safer to overact to the unknown than to do too little. Unfortunately, that means we tend to overestimate the risk of novel dangers.

I can cite you statistics until I am blue in the face, demonstrating that your risk of dying from the virus is minuscule compared with your risk of dying from everyday threats, but I doubt you'll be reassured. Just as we tend to assume the worst about novel threats - the safest, if not the most statistically justifiable, strategy - we tend to underestimate the danger of familiar risks because we are habituated to them. We are not very rational when it comes to assessing risk.

The good news is that even in the face of fear, we do have the capacity to act in ways that would help limit contagion during an epidemic. Specifically, we can behave altruistically, which benefits everyone. For example, research shows that when people are told that it is possible - but not certain - that going to work while sick would infect a co-worker, people are less willing to stay home than when they are reminded of the certainty that going to work sick would expose vulnerable co-workers to a serious chance of illness.

Stressing the certainty of risk, in other words, more effectively motivates altruism than stressing the possibility of harm. Health officials should be explicit in telling the public that selfish responses to an epidemic, such as going to work while sick or failing to wash your hands, threaten the health of the community.

There are other ways to encourage selfless behaviour. For example, another study examined the neural activity of people while they played a game in which they made either generous or selfish choices to award or withhold money. The researchers found that when subjects made selfish decisions, the brain's reward centre was activated, whereas when they made generous decisions, a region of the brain implicated in empathy lit up. This suggests that people are more likely to be altruistic if they are primed to think of others and to imagine how their behaviour might benefit them.

There is no question that we can all be encouraged to act in the interest of our fellow humans during perilous times. Specifically, public figures need to convey loudly and clearly that we should not go to work or travel when we're sick and that we should not hoard food and medical supplies beyond our current need.

But that will require morally authoritative leaders who can inspire the better angels of our nature by reminding us that we are all in this epidemic together.


Richard A. Friedman is a professor of clinical psychiatry and director of the psychopharmacology clinic at the Weill Cornell Medical College.

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